Why Therapy Doesn’t Work for People
January 31, 2025
Author | Hannah Hill
It’s hard as a therapist to hear that therapy doesn’t work for some people. Of course my hope is that it works for all people! I think it’s important to examine some of the reasons therapy doesn’t work. Here are some of the common pitfalls I hear from folks.
– It’s Just Complaining –Whenever I tell someone I’m a therapist, the response is always curious. I usually get some version of “Oh wow, it must be so hard to listen to people complain all day.” The truth is, I don’t listen to people complain all day. The clients I work with are highly motivated, solution-focused, and more often than not, really want to make positive changes in their lives. They are not wallowing in their problems, they are not complaining about things and failing to take action, they are not hopeless, helpless, worthless humans who have nothing better to do than pay someone to listen to them bitch and moan. The people I work with are individuals who are contributors to their community, actively involved family members, and people who usually give 110% to nearly ever endeavor they are involved in. Since treating anxiety is my jam, I tend to attract clients to therapy who want to ace the test. They want to do therapy better than anyone has ever done therapy. That’s a noble goal but one that I give you full permission to put to the side for your own sake: I don’t give grades in therapy. And if I did, everyone would get an A for showing up because that’s the hardest fucking part.
Therapy looks different for everyone. Here are some examples. Client #1 comes into session, has a notebook and an agenda. They have 2-3 examples of distressing situations and they explore what happened in each of them. They review strategies I’ve introduced in session and their efficacy in the real world. They ask questions about what they could have done differently and solicit feedback about what went well. Then, they devise a plan to address any of these situations differently in the future. Client #2 comes into session, tells me all about the family events they attended, they laugh about silly things that happened, cry about sad things that happened. They discuss work stress and a fight they had with their partner. They highlight what went wrong, give themselves grace for not being perfect, and get a little validation that what they are going through is completely within normal limits. They breathe a sigh of relief for having said the things out loud and leave those problems in the session a little lighter.
– There’s Too Much Stigma –There are signs all over our society about how we devalue mental health and its treatment. If you don’t believe me, ask your average therapist working for a non-profit agency what they make annually. It is infuriating and sad what that number says about how we value the mental health of our most vulnerable populations. We commonly use therapy as a punishment or label (i.e. “If you don’t change, you have to go to therapy.” “Something’s wrong with you, you need a therapist!”). We use harmful and incorrect labels like “crazy” or “bipolar” to describe someone when they are having a big reaction to something. This often happens to women but that’s another blog post for another day. The fact is, we ALL have mental health issues! Some people don’t want to acknowledge that but the reality is that being a human is hard (one of my long-time clients has said this in session and I’m stealing the phrase because it’s so true). So of course we are going to struggle mentally. Because getting up each day to face whatever obstacles life has in store for you can take a toll on you. I don’t know anyone that hasn’t had a bad day, a fight with a loved one, a stressful work experience…and while those things alone don’t account for mental health disorders, they certainly do impact our mental health. Therapists use this analogy often: if you have diabetes and need insulin to help regulate that particular health condition, most of the time you are not labeled as weak for your body not being able to regulate its blood sugar. But if you have chronic, debilitating anxiety which leaves you feeling panicked, restless, and scattered for the majority of your day, then why do we deem people who need to regulate their brain (an organ) and choose to do so with therapy? Or even medication? It makes no sense. This is why stigma is so important to discuss when we talk about what therapy is like. Because it comes into play so frequently.
– The Therapist is Wrong –The right therapist makes all the difference. Here’s an example: a client sought a therapist after her first child was born. Her newborn was a terrible sleeper and she felt like she was going insane. She was working a stressful job, terribly underpaid, had a supervisor who couldn’t do their job so she was basically doing it for them, she was a new mom, had just moved to a new town after living in the same city for 10 years, and was anxious and angry all of the time. She didn’t enjoy parenting and felt isolated and alone a lot of the time. She went to therapy and did a lot of bitching and moaning about work. She also complained about housework and responsibilities in the home. And as a result, the one piece of information she gained from therapy with this particular therapist was a recommendation for a cleaning product. Because that’s the only thing the therapist ever said in the session—no joke. The client would go in, talk for 50 minutes and the therapist said not one freaking word. Just looked at her and nodded. Even during those natural breaks in conversation. It made the client feel like she was boring the therapist and instead of feeling validated and heard, she felt like a bother. That therapist is probably a highly skilled and competent therapist. But her approach was not the right fit at all.
When people tell me that therapy didn’t work because they don’t like the therapists they’ve had, I encourage them to keep trying. Some people are really lucky and click with the first therapist they meet. Not everyone has that experience and it’s certainly OK to “shop around” for the best fit. It’s also perfectly acceptable to stop seeing a therapist if after a few sessions, you’re just not feeling it. In that situation, I recommend talking with the therapist about it because there’s nothing more puzzling than a client who ghosts you for no apparent reason and sometimes the therapist is completely oblivious to the mismatch. A therapist is someone you have to connect with, feel comfortable with, be willing to trust (blindly at first but overtime it builds). If you happen to be reading this, live in Pennsylvania, and have been searching for the right therapist, reach out. I’d be happy to connect to see if we’re a good fit—and if not, provide referrals for some who might be.